Archive for the “Low-Fat Nonsense” Category

Surprise, surprise … my critique of Dr. Ornish’s recent “meat kills!” nonsense drew the ire of a vegetrollian. These people show up and now and then, always singing from the same hymnal. More than four years ago, I wrote a long post to answer them so I don’t have to waste time writing the same replies over and over in comments. I decided it’s time for an updated version. I’ll be busy this week, so this is probably my last post until Monday.

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Dear Vegetarian Evangelists:

Since you keep showing up on my blog and trying to convert me to the Church of the Holy Plant-Based Diet, I’ve decided it’s time once again to explain, in this new and improved post, why you’re wasting your time. You seem like nice people and all, but really, this is getting tiresome. Every time I answer the doorbell, you stand on my porch and repeat the same old sermons by the same old preachers: Joel Fuhrman, John McDougall, Dean Ornish, T. Colin Campbell, etc. This may surprise you, but I don’t find those sermons any more convincing on the 100th repetition than I did on the 10th.

Perhaps I’d pay attention if I actually heard a new sermon now and then, but sadly that’s never the case. So in the future, when you ring the bell, I’m going to simply refer you to this post and bid you good-day.

I know some of you will label this as closed-minded. That’s because to an evangelist, the definition of “closed-minded” is “does not agree with me.” The truth is, I’m being polite. Even though I believe your religion is based on a mixture of emotions and faulty reasoning, I don’t show up on your doorstep and try to talk you out of it. Unlike you, I don’t get emotionally involved in other people’s dietary choices. If you believe it’s better for humans to shun animal foods, please do so. I don’t really care.

But you obviously care very much that I eat meat, since you keep trying to convince me I shouldn’t. Sometimes it seems as if you all got together and said, “There’s a meat-eater who lives in that blog over there! We must take turns showing up on his doorstep and preaching to him until he sees the light!” I give you credit, by the way, for attempting to cloak your arguments in something resembling science. You apparently noticed the “Meat is Murder!” tactic just makes me laugh, so you’ve taken to presenting the same sentiment as a health issue.

Nice try, but it isn’t going work, and I’m going to explain why. I’m not foolish enough to think I’ll change your minds — evangelists aren’t swayed by evidence, as Eric Hoffer explained brilliantly in his book The True Believer – but I figure there’s an outside chance you’ll finally realize I don’t find your arguments the least bit persuasive, in which case you actually might give up and go away.

WHY I’M AN EX-VEGETARIAN … AND WHY I THINK VEGETARIAN EVANGELISTS ARE FULL OF BEANS.

I’ll start with the reason that’s the least valid scientifically, but frankly the only one that ultimately matters to me: my own experience. I was a vegetarian for several years (yes, I’m a fallen-away believer) yet somehow never experienced all the magic health benefits promised to me by your preachers. I did, however, experience arthritis, asthma, psoriasis, gastric reflux, restless legs, lower back pain, irritable bowel, fatigue, slow but consistent weight gain, listlessness, depression, frequent colds, canker sores, cavities, and receding gums that required grafts.

None of those ailments was caused by sugar consumption, because I already knew sugar was a sin and didn’t indulge except on very rare occasions. I’ve since learned that some of those ailments were likely caused by a lack of fat and cholesterol in my diet, while others were likely caused by the gluten and lectins found in grains.

Now that I’ve gone over to the dark side of low-carb/paleo eating, I don’t suffer from those ailments anymore — not one. It’s also no longer a battle to keep my weight down. I’m 56 years old, but look and feel better than when I was 36. I’m almost never sick and, unlike most people my age, I don’t take any prescription drugs. My only appointments with doctors in the past five years have been for regular checkups or to treat an injury.

Given my personal history, I don’t really care how much cherry-picked evidence bean-eaters like Ornish and McDougall can cite, because my body told me they’re wrong. I listen to my body. If I whack myself in the head with a rubber mallet and my body says, “You know, that gave me a headache and made me dizzy,” I’m not going to do it again – even if you cite a Fuhrman study concluding that head-whacking improves mood and prevents sexual dysfunction.

I also have to consider the experiences of my friends and acquaintances. I’ve known plenty of vegetarians over the years, and as far as health status goes, I wouldn’t trade places with any of them. They’re all on prescription drugs. I’ve seen them suffer from arthritis, auto-immune diseases, bone degeneration and cancer, to name just a few. One vegan friend in Los Angeles had to undergo extensive dental surgery because she lost half the bone mass in her jaw.

But of course, those are mere anecdotes and therefore aren’t scientifically valid. Now, you and I both know you’re only interested in the so-called “science” that supports your religion, but since you insist on pretending otherwise, I’ll deal with your science (ahem, ahem) as well.

First, let’s look at some basic principles of science. In real science, we control for confounding variables when testing a hypothesis. The studies you cite when you show up to preach at me are almost always observational studies, which are notoriously awful when it comes to controlling variables.

In real science, we also have to start with reliable data. Those observational studies are almost always based on food questionnaires that are sent out once per year, or once every five years, or even once every 10 years. The accuracy of those questionnaires is laughable. Some people report eating so little, they’d be walking skeletons.

Here’s what a food questionnaire looks like, by the way:

Over the last 12 months, how often did you eat the following foods? (Ignore any recent changes.)

Whole milk (4%), NOT in coffee, NOT on cereal: Never | 1-6 per year | 7-11 per year | 1 per month | 2-3 per month | 1-2 per week | 3-4 per week | 5-6 per week | 1 per day | 2-3 per day | 4-5 per day | 6+ per day. Portion size: less than ½ cup | ½ to 1 cup | more than 1 cup.

Breads or dinner rolls, NOT INCLUDING ON SANDWICHES: Never | 1-6 per year | 7-11 per year | 1 per month | 2-3 per month | 1-2 per week | 3-4 per week | 5-6 per week | 1 per day | 2-3 per day | 4-5 per day | 6+ per day. Portion size: less than 1 slice or roll | 1 or 2 slices or rolls | more than 2 slices or rolls.

Ground beef in mixtures such as tacos, burritos, meatballs, casseroles, chili, meatloaf: Never | 1-6 per year | 7-11 per year | 1 per month | 2-3 per month | 1-2 per week | 3-4 per week | 5-6 per week | 1 per day | 2-3 per day | 4-5 per day | 6+ per day. Portion size: less than 3 ounces | 3 to 7 ounces | more than 7 ounces.

You can get a sense of the accuracy of food questionnaires without even seeing one: just take out a piece of paper now and write down how many portions of asparagus you ate in the previous year. What, you can’t do it? Well then, let’s make it easier. How many ounces of whole grains did you consume in the past month?

You don’t know, do you? And if you do know, you’re a diet freak who tabulates everything you eat, which means you in no way represent people in the general population.

If you’re not a diet freak and you were filling out the questionnaire, you’d do like most people — take a wild guess. I once worked at a company where we were required to fill out a food questionnaire as part of a survey. My co-workers and I laughed about the stupidity of anyone believing we could accurately recall detailed dietary information. We took our wild guesses, filled in the form, and got back to our real jobs.

So Ornish and McDougall can cherry-pick a few studies that link saturated fat to heart disease and cancer … so what? I’m sure that’s true to an extent, at least in America. But some of the biggest sources of saturated fat in the American diet are grain-based desserts (sugar and refined flour), dairy desserts (sugar), pizza (refined flour) and Mexican dishes (refined flour). Do you see any possible confounding variables there?

Most people who become vegetarians do so because they believe (mistakenly) that giving up meat with make them healthier. That makes them a self-selected group of health-conscious people. Health-conscious people are different from the rest of the population. They’re less likely to smoke, drink to excess, take drugs, consume candy and sodas, or eat highly processed foods. They’re more likely to exercise, take vitamins, etc. So of course they’re healthier on average than the general population, which includes a lot of people who don’t give a @#$% about their health and have lousy health habits. That makes direct comparisons between vegetarians and the non-vegetarian population as a whole meaningless.

For example, when one of you rings my doorbell, I know it’s only a matter of time before you start yammering on about an observational study of Seventh-Day Adventists. Yes, they’re vegetarians. Yes, they have better health and longer lifespans than the population as a whole. That’s because they’re exactly like the people I described above: they don’t smoke, drink, do drugs, eat candy, drink sodas, etc. I have a Mormon friend who also doesn’t smoke, drink, do drugs, drinks sodas, etc., because her religion prohibits those behaviors. And guess what? Mormons, like Seventh-Day Adventists, are much healthier and live much longer than the population as a whole. But they do eat meat.

If the only difference between Seventh-Day Adventists and the rest of the population was meat vs. no meat, you might have a point. But that’s not the only difference. Not by a long shot. That’s why observational studies are lousy as evidence.

How lousy? According to Dr. John Ioannidis, a Harvard M.D. and mathematician who has spent decades studying old studies, 80 percent of the conclusions drawn from observational studies have turned out to be wrong. Got that? Eighty percent. So when you ring my doorbell to warn me that New Study Links Meat To Blindness! or whatever, what I hear is: New Study That Is Far More Likely To Be Wrong Than Right Links Meat To Blah-Blah-Blah.

But let’s suppose for the sake of argument that observational studies actually tell us something. Here’s another basic principle of science: a hypothesis isn’t considered valid unless the evidence supporting it is consistent and repeatable. The evidence has to hold up across time and geography. Your Meat Kills! evidence doesn’t.

There have been native peoples all over the world who lived primarily on animal flesh and animal fat — the Masai tribes, our own buffalo-hunting tribes, the Inuits, etc. — but heart disease was nearly non-existent among those people. Doctors who visited them were stunned at how healthy they were. The buffalo-hunting tribes didn’t become fat, diabetic, and plagued with heart disease until they stopped hunting and started living on sugar and flour.

A century ago, Americans consumed four times as much butter and lard as we do now, but again, heart disease was quite rare. We didn’t see a surge in heart disease until we began eating a lot more sugar and substituting processed vegetable oils for animal fats. Even today, the French and Swiss consume far more cream, butter, cheese and pork than Americans, but have a much lower rate of heart disease. (They do, however, consume far less sugar, soda, processed vegetable oils, and white flour.)

Those are general observations. Let’s get more specific. After all, I’m sure you’ve been indoctrinated by the Church of the Holy Plant-Based Diet to cite a few specific observational studies linking meat to heart disease, cancer, early death, etc. So here are some specific studies that prove those results aren’t consistent and repeatable.

Colinearity between red meat intake and other dietary factors (e.g. Western lifestyle, high intake of refined sugars and alcohol, low intake of fruits, vegetables and fibre) and behavioural factors (e.g. low physical activity, high smoking prevalence, high body mass index) limit the ability to analytically isolate the independent effects of red meat consumption. Because of these factors, the currently available epidemiologic evidence is not sufficient to support an independent positive association between red meat consumption and colorectal cancer.

In other words, when they try wading through the confounding variables, they can’t come up with a significant link between red meat and colorectal cancer.

Our findings do not support the hypothesis that consumption of red meat increases colorectal cancer risk but do suggest that high intake of fish may decrease the risk, particularly of distal colon cancer.

Red meat isn’t linked to a higher rate of colon cancer, but fish is linked to a lower rate. I don’t think you vegan zealots will care much for that result. Fish are animals, right?

Our pooled analysis found no association between intake of total meat (red meat, poultry, and fish/seafood) and risks of all-cause, CVD, or cancer mortality among men and women. Red meat intake was inversely associated with CVD mortality in men and with cancer mortality in women in Asian countries.

Let me explain “inversely associated” in case you’re a total illiterate when it comes to science: that means men who ate more red meat were less likely to die of heart disease, and women who ate more red meat were less likely to die of cancer.

Within the study, the incidence of all cancers combined was lower among vegetarians than among meat eaters, but the incidence of colorectal cancer was higher in vegetarians than in meat eaters.

Hey, there you go! A result all you disciples of the Church of the Holy Plant-Based Diet can use to spread The Word. The vegetarians had lower overall cancer rates, so let’s cherry-pick this one study and start ringing more doorbells!

Oh, but wait … the vegetarians also had higher rates of colorectal cancer. That’s the type of cancer you vegan zealots are always warning me I’ll get as the result of eating meat. Hmmm …

As any decent scientist will tell you, correlation doesn’t prove causation. But a lack of a correlation is pretty danged strong evidence that there’s no causation … because if one thing causes another, they will be correlated — consistently. We not only don’t see consistent correlations between meat and higher rates of heart disease or cancer, we can find studies like the one above in which more meat was correlated with lower rates of those diseases.

I could go on and on, but I hope you’ve grasped the point by now: the observational evidence delivered from the pulpit by Ornish, Fuhrman, McDougall and your other high priests is cherry-picked. Those observations don’t hold up across time or geography. They don’t even hold up in modern Western countries if you look at all the studies instead of just the ones your priests selected for you. Not consistent and not repeatable means the hypothesis isn’t valid.

Clearly something other than animal fat causes heart disease — my guess is sugar and refined carbohydrates, because that result does hold up. Go around the world, look at different cultures throughout time, and you’ll see that heart disease, cancer, and other “diseases of civilization” show up shortly after sugar and white flour become dietary staples.

Many of you have preached to me that the Fuhrman-McDougall-Ornish diet is superior because it lowers cholesterol. I’ve got news for you: That’s one of the least convincing arguments you can make, because I don’t want my cholesterol lowered. Have you ever checked the data on cholesterol levels vs. mortality? I have. The graphic below shows total cholesterol plotted against all-cause mortality using data from 164 countries.

I apologize for the teensy type, but check the blue line. That’s all-cause mortality. Notice how it reaches the lowest point at a cholesterol level of around 220? Your high priests brag about how their diets lower cholesterol, but the data shows that people with low cholesterol have shorter lifespans. They’re more likely to die of cancer, stroke, infections and suicide.

Yeah, yeah, yeah, I can sense you reaching for that chapter from the prayer book already: “No, you see, cancer CAUSES low cholesterol!” Uh-huh. If high cholesterol is linked to heart disease, it must mean cholesterol is causing the disease. But if cancer is linked to low cholesterol, by gosh, it must be the other way around — because preacher Fuhrman says so. Since the low cholesterol often shows up years before the cancer, that’s quite a trick. And good luck explaining how strokes and suicide cause low cholesterol.

But about that link between high cholesterol and heart disease: it doesn’t actually exist, except in males below the age of 65 living in a few countries. It certainly doesn’t hold up around the world. Some of you have quoted McDougall as saying he’s never seen a heart attack in anyone with cholesterol below 150. (Notice he didn’t say he’s never seen cancer or a stroke.) Well, if that’s true, it merely means McDougall has never visited Australia. Aborigines have one of the lowest average cholesterol levels in the world. They also have one of the highest heart-disease rates. Autopsies have shown plaque-filled arteries in heart-attack victims whose total cholesterol was as low as 115. If high cholesterol causes heart disease and low cholesterol cures it, how is that possible?

Some years ago, I dug up the WHO data on average cholesterol levels and heart-disease rates around the world. If high cholesterol causes heart disease, then plotting those figures against each other would produce a nice, recognizable trend-line. And as it happens, I did plot them against each other. You can see the result below:

Do you see a trend-line there? I certainly don’t. When I ran the CORR function in Excel, it showed a very slight negative association between cholesterol and heart disease — in other words, higher cholesterol was correlated with slightly lower mortality from heart disease.

I found a similar result when I ran an analysis on the American Heart Association’s own data: people with LDL over 130 actually have a slightly lower rate of heart disease than people with LDL below 130.

So once again, the observations your preachers made that you keep quoting don’t hold up. They’re not consistent, and they’re not repeatable. Therefore, they’re not scientifically valid.

Many of you have offered yourselves as evidence that the Fuhrman-McDougall-Ornish diet works. Some of you have even sent me pictures of your now-skeletal bodies, apparently thinking I’d be impressed. I wasn’t. I have no desire to look like I take my meals in a concentration camp.

If your health improved, I’m happy for you. But you might want to ask yourself which aspect of the diet improved your health. Your preachers insist you give up animal foods, but also sugar and refined carbohydrates. Then when your health improves, they offer it as proof that animal foods were the problem and only the Holy Plant-Based Diet can lead to eternal health and happiness.

But I also gave up sugar and refined carbohydrates, and my health also improved, despite adding more animal fat to my diet. Hey, ya know … perhaps it’s the sugar and refined flour that are the real problem here.

You’ve preached about how Ornish and Furhman have reversed heart disease in their patients. Fine, I believe you. But so have doctors like William Davis and Al Sears, and they don’t tell their patients to give up animal foods; they tell their patients to give up sugar and refined carbohydrates (as do Ornish and Furhman). Rocky Angelucci, author of Don’t Diet Early, followed the program designed by Dr. Davis and reversed the plaque in his coronary arteries by 24 percent in six months. A friend of mine went on the Atkins diet — no sugar, no refined carbohydrates — and his labs improved so much, his doctor took him off his statin and said, “Whatever you’re doing, keep doing it.”

Notice anything consistent about the diets that reverse heart disease?

If merely giving up animal fats and switching to all plant-based foods were the key to avoiding heart disease, that result would hold up around the world. But it doesn’t. Vegetarians in India have one of the highest rates of heart disease in the world — higher than the Indians who aren’t vegetarians. They don’t eat meat, but they do consume sugar and flour.

Here’s a quote from an article about Bill Clinton’s vegan diet:

When Caldwell Esselstyn spotted a picture of him on the Internet, eating a dinner roll at a banquet, the renowned doctor dispatched a sharply worded email message: “I’ll remind you one more time, I’ve treated a lot of vegans for heart disease.”

So even a priest of the Church of the Holy Plant-Based Diet admits vegans can develop heart disease — by eating white flour.

Since your religious tracts are full of cherry-picked observational evidence, I’m going to close by asking you to make an observation for me … just one, and if your preachers are correct, this should be easy: Name the cultures, now or in the past, where people subsisted on a diet high in animal foods and animal fats but consumed little or no sugar and flour, yet had high rates of heart disease and cancer. If you can do that, I’ll answer the bell and listen to you preach the next time you feel like asking me to join the Church of the Holy Plant-Based Diet.

Until you can do that, go away. You don’t stand a chance of converting me.

It must be tough to be Dr. Dean Ornish these days. The man desperately wants to convince everyone to live on a low-fat vegetarian diet, and yet the Wisdom of Crowds effect is turning the tide in the opposite direction. People previously frightened into giving up eggs and red meat have gone paleo, improved their health, and announced as much to the crowd. Books like The Big Fat Surprise are shining a very bright light on the shoddy science that led to anti-animal-fat hysteria in the first place. Researchers are revisiting the science and declaring the low-fat diet a mistake.

This can’t sit well at all with Dr. Ornish, for whom the plant-based diet is clearly akin to a religion. In fact, I suspect that like many vegetarians and vegans, the thought process that formed his beliefs went something like this:

Giving up animal foods must improve your health – a reward for no longer being a sinner.

Ornish has spent his career warning of the health hazards of animal foods. The emerging evidence – the reliable kind, anyway – keeps contradicting him, so now he’s like a walking, talking example of the people described in the terrific book Mistake Were Made (but not by me): having staked out a very public position, he can’t possibly change his mind without committing career suicide. He must cling to that position to the bitter end.

And so Ornish pops up now and then to bang the Animal Foods Kill! drum yet again … by pointing to a lousy observational study here and a mouse study there. You never hear him quoting clinical studies on humans (i.e., the studies that actually matter) because those don’t support his beliefs.

Ornish’s latest attempt to bang the drum came in the form of an essay in the New York Times, which several readers called to my attention. Let’s take a look.

Many people have been making the case that Americans have grown fat because they eat too much starch and sugar, and not enough meat, fat and eggs. Recently, the Dietary Guidelines Advisory Committee lifted recommendations that consumption of dietary cholesterol should be restricted, citing research that dietary cholesterol does not have a major effect on blood cholesterol levels. The predictable headlines followed: “Back to Eggs and Bacon?”

But, alas, bacon and egg yolks are not health foods.

And we know they’re not health foods because Dr. Ornish says so.

Although people have been told for decades to eat less meat and fat, Americans actually consumed 67 percent more added fat, 39 percent more sugar, and 41 percent more meat in 2000 than they had in 1950 and 24.5 percent more calories than they had in 1970, according to the Agriculture Department. Not surprisingly, we are fatter and unhealthier.

Notice how Ornish lumps added fat, sugar and meat together, attempting to paint them as members of the same murderous gang. It’s a bit like stating that the trio of Jeffrey Dahmer, Ted Bundy and Mother Teresa were responsible for more than 50 brutal murders. That’s technically true, but Mother Teresa’s share of the carnage was zero.

But what about that increase in added fat? Did we become fatter and unhealthier by consuming more butter and lard?

The added fats are mostly vegetable oils – the exact type the vegetarian zealots insist are better for us than animal fats. Ornish reached way back to 1950 to grab figures on meat consumption so he could make a dramatic comparison with today and thus blame meat for obesity rates that began rising … wait for it … 30 years later. Let’s back up instead to 1970, when Americans were still lean on average and not suffering from record rates of diabetes.

Meat consumption rose by 13 percent from 1970 to 2005, but mainly because we eat a lot more chicken. During that same timespan, red meat consumption dropped by 22%, egg consumption dropped by 17%, and dairy consumption dropped a wee bit. Meanwhile, grain consumption increased by 45%.

Keep those figures in mind as we continue quoting Dr. Ornish.

The debate is not as simple as low-fat versus low-carb. Research shows that animal protein may significantly increase the risk of premature mortality from all causes, among them cardiovascular disease, cancer and Type 2 diabetes.

Dr. Ornish includes a link that goes to a study I already analyzed in this post. It’s another one of those number-crunching analyses of two lousy observational studies based on food questionnaires. Other analyses of the same parent studies (The Health Professionals Follow-up Study and the Nurses’ Health Study) have consistently shown that the participants who ate the most meat and eggs were also more likely to smoke, to drink, to be overweight, etc. In other words, we’re comparing adherers vs. non-adherers, not the effects of any one food.

But since Dr. Ornish apparently believes observational studies are rock-solid evidence, perhaps he can explain these results from a study of the Japanese elderly:

Nutrient intakes in 94 Japanese centenarians investigated between 1972 and 1973 showed a higher proportion of animal protein to total proteins than in contemporary average Japanese.

High intakes of milk and fats and oils had favorable effects on 10-year (1976-1986) survivorship in 422 urban residents aged 69-71.

The survivors revealed a longitudinal increase in intakes of animal foods such as eggs, milk, fish and meat over the 10 years.

I guess animal foods will kill you unless you’re Japanese, in which case they extend your life.

Back to Dr. Ornish:

Heavy consumption of saturated fat and trans fats may double the risk of developing Alzheimer’s disease.

Once again, notice how he lumps trans fats and saturated fats together. The vegetarian and vegan zealots do that all the time – well, at least now that they’ve admitted trans fats are bad. Back in the 1980s, The Guy From CSPI was pushing trans fats as a safe alternative to animal fats. Point is, trans fats and saturated fats have very different effects on your health – which Dr. Ornish chooses to ignore.

A study published last March found a 75 percent increase in premature deaths from all causes, and a 400 percent increase in deaths from cancer and Type 2 diabetes, among heavy consumers of animal protein under the age of 65 — those who got 20 percent or more of their calories from animal protein.

Dr. Ornish forgot to mention a couple a couple of facts about that study:

It’s yet another observational study based on food questionnaires and is therefore nearly worthless.

Data from the same study showed that heavy consumers of animal proteins over the age of 65 had lower mortality and lower rates of heart disease and cancer, not higher.

So if this observational study actually tells us something about the health effects of animal protein (which it doesn’t), we’d have to conclude that meat will kill you until you turn 65, but after age 65 it will save your life.

Back to the good doctor:

Low-carb, high-animal-protein diets promote heart disease via mechanisms other than just their effects on cholesterol levels. Arterial blockages may be caused by animal-protein-induced elevations in free fatty acids and insulin levels and decreased production of endothelial progenitor cells (which help keep arteries clean). Egg yolks and red meat appear to significantly increase the risk of coronary heart disease and cancer due to increased production of trimethylamine N-oxide, or TMAO, a metabolite of meat and egg yolks linked to the clogging of arteries. (Egg whites have neither cholesterol nor TMAO.)

Ornish linked to a study to support that paragraph, so I checked it out. Here’s the abstract:

Mice that were fed a high-fat, high-protein, low-carbohydrate diet were found to have atherosclerosis that was not associated with traditional cardiovascular risk factors.

So I’m going to suggest you avoid (especially if you’re a mouse) the “Atkins Diet” version of laboratory rodent chow, which is a mix of corn starch, sugar, casein, and various fats including soybean oil, corn oil and Crisco.

Animal protein increases IGF-1, an insulin-like growth hormone, and chronic inflammation, an underlying factor in many chronic diseases. Also, red meat is high in Neu5Gc, a tumor-forming sugar that is linked to chronic inflammation and an increased risk of cancer. A plant-based diet may prolong life by blocking the mTOR protein, which is linked to aging.

To support those claims, Ornish referred to another mouse study and the observational study that showed a statistical link between meat and higher mortality up to age 65, but lower mortality after age 65. Since most of us will live to be 65 anyway, I think we can stop worrying about the meat. Eat it now, and after celebrating your 65th birthday, start eating even more of it.

Are you recognizing the Ornish method of persuasion by now? He’s like the Wizard of Oz, blowing a lot of smoke and bellowing loudly, but really hoping you don’t look behind that curtain. A quick reference to a mouse study (which he doesn’t identify as a mouse study), a quick reference to an observational study (citing one result but skipping the result he doesn’t want you to see), a quick conflation of trans fats and animal fats, and VOILA! – you’ve almost got an argument against eating animal foods.

Ornish continues:

An optimal diet for preventing disease is a whole-foods, plant-based diet that is naturally low in animal protein, harmful fats and refined carbohydrates. What that means in practice is little or no red meat; mostly vegetables, fruits, whole grains, legumes and soy products in their natural forms; very few simple and refined carbohydrates such as sugar and white flour; and sufficient “good fats” such as fish oil or flax oil, seeds and nuts. A healthful diet should be low in “bad fats,” meaning trans fats, saturated fats and hydrogenated fats. Finally, we need more quality and less quantity.

Hmmm … let’s rewrite that paragraph to reflect the actual evidence:

An optimal diet for preventing disease is a whole-foods diet that is naturally low in harmful fats and refined carbohydrates. What that means in practice is meat, eggs, vegetables, fruits and nuts, but little or no whole grains or soy products; very few simple and refined carbohydrates such as sugar and white flour; and sufficient “good fats” such as fish oil, natural animal fats, seeds and nuts. A healthful diet should be low in “bad fats,” meaning trans fats, processed vegetable oils, seed oils, and hydrogenated fats. Aim for quality, and you’ll probably find the quantity takes care of itself.

I didn’t bother to read all the comments on Ornish’s article, but I did come across this one:

So far, 331 comments posted. About 88% either disagree or have a different view than the author. I suppose if you agree with him, then you may not comment. But it is obvious the author is not connecting to his audience. I suspect he is not much different than other vegans I have met: for him, diet is a religion and he cherry picks the science.

Sorry, Dr. Ornish, but the jig is up. People aren’t buying these weak arguments of yours anymore. You can keep bellowing away about the hazards of animal foods, but it’s the information age now and the crowd knows better – and the crowd is loud.

If you’re around my age, you may remember when almost every commercial for cereal ended with the tagline: Part of this nutritious breakfast! Or, Part of this balanced breakfast! The “balanced” breakfast shown was always a bowl of cereal, two pieces of toast (because the cereal alone didn’t provide enough processed grain), a glass of milk and a glass of juice – usually orange juice.

Here are a couple of collections of old cereal ads I found on YouTube. The first is from the 1970s, the second from the 1980s:

Boy, cereal had some great flavors back in the day: chocolate, sugar, honey, cinnamon toast, more sugar, marshmallows, rocky road ice cream, even more sugar, and chocolate chip cookies. Trust me, Kellogg’s and General Mills had no problem convincing us to eat those “balanced” breakfasts. I think we may be looking at part of the reason rates of obesity began to take off around 1980.

Just for grins, I took clips from the videos above and stitched them into a little summary of my own:

Let’s look at the nutrition breakdown of that “balanced” breakfast the cereal manufacturers were promoting back then. Officially, a serving of cereal is cup or a half-cup, depending on the brand, but if you look at the commercials, those cereal bowls hold more like two cups – and I didn’t know any kids who ate just one cup of cereal for breakfast. They were called cereal bowls for a reason.

So I’ll go with two cups of Frosted Flakes, 2% milk (which is what we drank when I was an adolescent), Parkay Margarine (which was mostly trans fat back then) and Minute Maid orange juice from concentrate, the kind your mom mixed with water. Here’s what we get:

As a percent of calories, it works out to about 65% carbohydrate, 10% protein and 25% fat. Hey, I’ll be darned if those aren’t the proportions recommended by the USDA! No wonder people in my generation are so remarkably lean and free of diabetes.

I believe (or hope, anyway) that most parents these days know that cereals full of chocolate and marshmallows aren’t health food. But I’d bet many of them still believe a glass of orange juice is part of a nutritious breakfast.

Take a look at the sugar content in that glass of orange juice listed above. It’s a Coke with a bit of vitamin C. Now take a look at part of the abstract from a study in which investigators included orange juice with breakfast for one of the study groups, but not the other.

On 2 separate days, healthy normal-weight adolescents (n = 7) and adults (n = 10) consumed the same breakfast with either orange juice or drinking water and sat at rest for 3 h after breakfast. The meal paired with orange juice was 882 kJ (210 kcal) higher than the meal paired with drinking water. Both meals contained the same amount of fat (12 g). For both age groups, both meals resulted in a net positive energy balance 150 min after breakfast. Resting fat oxidation 150 min after breakfast was significantly lower after breakfast with orange juice, however. The results suggest that, independent of a state of energy excess, when individuals have a caloric beverage instead of drinking water with a meal, they are less likely to oxidize the amount of fat consumed in the meal before their next meal.

If you’re not oxidizing fat, you’re storing it. That’s why we never include orange juice (or apple juice, or grape juice, or any other fruit juice) in the nutritious breakfasts we serve at home – much less cereal and toast.

While looking for something else on the USDA’s official My Plate site last week, I came across a list of daily meal plans. I presume the meal plans are intended for people who are too stupid to simply look at the new and improved, colorful, easy-to-understand My Plate example and fill their plates accordingly. I don’t think people are that stupid, but the USDA clearly does. After all, when the Food Pyramid came along and people got fatter instead of thinner, the USDA took that result as evidence that the Food Pyramid was too confusing. Couldn’t possibly be that the advice was wrong.

Anyway, here are some screen shots of the sample menus for a 2,000 calorie diet:

Although it was a bit tedious, I looked up nutrition information for everything on the Day 1 menu and added it up. We’re looking at 2039 calories, 94 grams of protein, 82 grams of fat, and 254 carbohydrates. That’s not a huge carbohydrate load (although far more than I would consume), but look at some of the major carb sources: raisins, brown sugar, orange juice, lasagna noodles and a wheat roll. Fructose and wheat.

Go through the rest of the week online, and it’s more of the same. Sure, there are recommendations to eat vegetables, but there are also plenty of juices, English muffins, rolls, bread slices, crackers, cereals … heck, fat-free chocolate milk is even on the menu for Day 5. Every single cut of meat is specified as lean and every single dairy product is specified as low-fat or fat-free. Recipes call for margarine and corn or canola oil, but of course never butter. There’s almost no quality fat on the menu to make you feel full and nourished.

I would shrug it off and say most people will ignore these menus – which they will – but of course every public school, military installation, prison, government cafeteria, etc., etc. is required to serve meals like these.

The My Plate site is full of nonsense about how eating this way can help people lose weight. Riiiight. The only people who will lose weight because of these menus are the prisoners – and only because they can’t go out and stuff themselves with snacks after their USDA-approved meals leave them feeling hungry.

In my last post, I compared the organizations that have been promoting artercloggingsaturatedfat! hysteria for the past 40 years to prosecutors who refuse to believe they put an innocent man in prison — even when new evidence says that’s exactly what happened. Never mind that pesky new DNA test, they insist. You have to look at the totality of the evidence. Someone who either works for or believes in the American Heart Association even left a comment to that effect (along with a couple of links):

You don’t take fringe studies from 50 years ago that contradict the vast majority of lipid research over the last half century and make a conclusion. You look at the body of evidence.

Well, the Sydney Diet Heart Study wasn’t exactly a “fringe” study. It was a controlled clinical trial that ran for seven years and included 458 subjects. Unless human biology has changed in the past 50 years, the results are still relevant.

I’ll examine that “vast majority of lipid research” the commenter linked to in a moment. First I’d like to deal with the argument that we must consider the totality of the evidence.

No, we don’t. Good scientists don’t consider a hypothesis to be validated unless the evidence supporting it is consistent and repeatable. As the science philosopher Karl Popper explained, if your hypothesis is that all swans are white, as soon as I start finding black swans, your hypothesis is wrong. It’s been falsified. If you find 100 white swans and I only find three black ones, you might insist that the “totality of the evidence” is in your favor, and it is – but your hypothesis is still wrong.

Another reason I don’t buy the “totality of the evidence” argument is that selection bias and publication bias are both rampant in nutrition science. I’ve read papers where the conclusions simply weren’t supported by the actual data. Studies that don’t produce the results the investigators wanted are often buried. If your academic paper supports conventional wisdom, it’s far more likely to be published. As Dr. Uffe Ravnskov can tell you from personal experience, papers that challenge conventional wisdom are often rejected over and over, with little or no explanation … unless you consider “this just has to be wrong” an explanation. So when researchers decide to do a meta-analysis of published studies, there’s a good chance they’re analyzing a stacked deck.

With that in mind, let’s start by looking at some of the “totality of the evidence” offered by the arterycloggingsaturatedfat! crowd, then move on to a few black swans.

The first link from our “body of evidence” commenter was to this study, a meta-analysis of eight studies. And how were those studies selected? Did the investigators go out and examine the entire body of evidence? Hardly. Here’s a quote from the study:

Of 346 identified articles, 290 were excluded based upon review of the title and abstract. Full texts of the remaining 54 manuscripts were independently assessed in duplicate by two investigators to determine inclusion/exclusion. Forty-six studies were excluded because they did not meet inclusion and exclusion criteria.

Most of the “body of evidence” was excluded merely by reading titles and abstracts. I’m not claiming the investigators rejected studies that didn’t support conventional wisdom, but the potential for cherry-picking is certainly there. Out of 346 studies they identified, they ran their analysis on just eight.

To their credit, the researchers discussed the weaknesses of the eight studies they selected:

Many of the identified randomized trials in our meta-analysis had important design limitations. For example, some trials provided all or most meals, increasing compliance but perhaps limiting generalizability to effects of dietary recommendations alone; whereas other trials relied only on dietary advice, increasing generalizability to dietary recommendations but likely underestimating efficacy due to noncompliance. Several of these trials were not double-blind, raising the possibility of differential classification of endpoints by the investigators that could overestimate benefits of the intervention. One trial used a cluster-randomization cross-over design that intervened on sites rather than individuals; and two trials used open enrollment that allowed participants to both drop-in and drop-out during the trial. The methods for estimating and reporting PUFA and SFA consumption in each trial varied, which could cause errors in our estimation of the quantitative benefit per %E replacement. One of the trials also provided, in addition to the main advice to consume soybean oil, sardines to the intervention group, so that observed benefits may be at least partly related to marine omega-3 PUFA rather than total PUFA consumption.

Enough said about that one.

The commenter also left a link to this study, another meta-analysis published by our pals at the American Heart Association. Here’s pretty much all you need to read to realize we’re not exactly looking at overwhelming evidence:

Several randomized trials have evaluated the effects of replacing saturated fatty acids with PUFAs on CHD events. Intakes of PUFA (almost entirely omega-6 PUFA) ranged from 11% to 21%. In addition to the inability to double-blind these studies, many had design limitations such as small sample size (n=54), the provision of only ≈50% of meals, outcomes composed largely of “soft” ECG end points, randomization of sites rather than individuals with open enrollment and high turnover of subjects, use of vegetable oils that also contained the plant omega-3 fatty acid α-linolenic acid, and simultaneous recommendations to increase fish and cod liver oil use.

Think we have enough confounding variables there? The “totality of the evidence” doesn’t appear to be very convincing. I believe an intelligent jury would have to conclude there’s more than a little reasonable doubt. So let’s move on to some black swans.

The American Heart Association’s advice is based on the belief that saturated fat raises cholesterol, and high cholesterol causes heart disease. Replace those arterycloggingsaturatedfats with polyunsaturated or monounsaturated fats, and you’ll lower your cholesterol, thus preventing a heart attack.

Does eating saturated fat raise your cholesterol? Perhaps, but not necessarily. Look what happened in this study:

Multiple food allergies required a group of seven patients with elevated serum cholesterol levels to follow a diet in which most of the calories came from beef fat. Their diets contained no sucrose, milk, or grains. They were given nutritional supplements. This is the only group of people in recent times to follow such a diet. During the study, the patients’ triglyceride levels decreased from an average of 113 mg/dl to an average of 74 mg/dl; at the same time, their serum cholesterol levels fell from an average of 263 mg/dl to an average of 189 mg/dl. At the beginning of the study, six of the patients had an average high-density lipoprotein percentage of 21%. At the end of the study, the average had risen to 32%. These findings raise an interesting question: are elevated serum cholesterol levels caused in part not by eating animal fat (an extremely “old food”), but by some factor in grains, sucrose, or milk (“new foods”) that interferes with cholesterol metabolism?

When I cut the carbohydrates and increased my animal-fat intake, my total cholesterol dropped, my LDL dropped, my triglycerides dropped, and my HDL went up. That’s what happened with the patients in this study as well. So perhaps saturated fat, if it’s harmful at all, is only harmful in the context of diet that includes sugars and grains – exactly the point Dr. Richard Feinman has made over and over.

Switching to vegetable oils can indeed lower cholesterol levels, but that does translate to fewer heart attacks? That’s what the American Heart Association tells us. But once again, I see black swans in the sky. In the Sydney Diet Heart Study that started this debate, the men who switched to safflower oil lowered their cholesterol by an average of 13%. That means a subject whose total cholesterol was 230 (deemed unsafe by the AHA) would, on average, end up with total cholesterol of 200 – the recommended level. And yet the men whose cholesterol was lowered by substituting polyunsaturated fats for animal fats ended up with a higher mortality rate, including higher mortality from heart disease. I’d call that a rather dramatic black swan.

In this study, the researchers were able to lower cholesterol levels by having a control group of men switch to soybean oil. Here are the results:

The test diet lowered the serum-cholesterol from a mean initial figure of 272 to 213 mg. per 100 ml. at six months (22% fall); the level in the controls fell from 273 to 259 mg. per 100 ml. (6% fall). Suspected relapses were assessed at regular intervals by a review committee unaware of the patient’s diet group. 62 men on the test diet suffered at least one relapse during the period of observation compared with 74 of the controls. 40 of the first relapses in the test group were major (i.e., definite reinfarctions or deaths from coronary heart-disease) compared with 39 major first relapses in the controls. The total number of men who had a major relapse at any time in the trial was 45 in the test group and 51 in the controls; of these major relapses 25 in each group were fatal. None of the differences found is significant. Relapses were not related to initial cholesterol level, to change in cholesterol level during the trial, nor, in any consistent way, to observance of the dietary regimen.

Once again, we see a dramatic fall in cholesterol levels, but no difference in heart-attack deaths. That looks like another black swan to me.

Four hundred fifty-eight men with coronary heart disease participated in a trial of secondary prevention for 2 to 7 years. Overall five year survival was 81%. For those with first heart attacks it was 86%.

From infarct to entry into the trial the majority of men had already made changes in their diet and smoking habit and has lost weight. They were allocated randomly to two dietary groups. In one group the diet consumed derived 9.8% of calories from saturated fatty acids and 15.1% from polyunsaturates. In the second group saturated fatty acids contributed 13.5% and polyunsaturated fatty acids 8.9% of total calories. Survival was slightly better in the second group. Multivariate analysis showed that none of the dietary factors were significantly related to survival.

No significant difference, and what difference there was favored the group that consumed more saturated fat.

I saved my favorite for last. In this study, men with existing heart disease were divided into three groups: the control group maintained their normal diet, a second group was instructed to cut back on animal fats and consume polyunsaturated corn oil, and the third group was instructed to cut back on animal fats and consume monounsaturated olive oil. You know, olive oil – the stuff that’s supposed to prevent heart attacks. Here’s a quote from the full text of the study:

Patients in both oil groups were instructed to avoid fried foods, fatty meat, sausages, pastry, ice-cream, cheese, cakes (except plain sponge), etc. Milk, eggs, and butter were restricted. An oil supplement of 80 g./day was prescribed, to be taken in three equal doses at meal-times. The general nature and purpose of treatment were explained, together with the fact that different patients were receiving different kinds of oil. No advice on dietary fat was give to control patients.

The men in the two invention groups were monitored and counseled every month at first, then every two months. Investigators then tracked cardiac deaths and cardiac events for two years. The control group, by the way, was the oldest on average: 58.8 years vs. 55 years for the olive-oil group and 52.6 years for the corn-oil group. Considering that heart-disease rates increase dramatically as people move through their fifties, I think that’s significant. Nonetheless, here are the results from the study:

At two years the proportion of patients remaining free of major cardiac events is greater for the control group (75%) than for the two oil groups (olive oil 57%, corn oil 52%). The likelihood that the difference between the control and corn-oil groups was due to chance is 0.05-0.1 (S.E. of difference, + 13 %). Among those patients who were followed for a third year no new trend emerged.

Strangely, the researchers concluded that corn oil isn’t a good treatment for heart disease, but said nothing about olive oil.

If you’re a sympathetic sort, you could almost feel sorry for people who work for the American Heart Association, the British Heart Foundation, the Australian Heart Foundation, etc. They’ve been promoting anti-fat hysteria for more than 40 years now, people have dutifully cut back on their saturated fat intake and consumed more “heart-healthy” grains, and yet our societies are witnessing record rates of obesity and diabetes. Even if these organization believe their advice is correct, I don’t see how they could feel successful in their missions.

But of course, their advice isn’t correct.

I’m not a big fan of observational studies, but since the American Heart Association likes to cite them as evidence, here’s a conclusion several observational studies have reached: when people replace saturated fats with refined carbohydrates, their rate of heart disease goes up, not down. Clinical studies show that refined carbohydrates raise triglycerides, and high triglycerides at at least associated with heart disease, if not an actual cause. And yet for decades now, the AHA has been putting its stamp of approval on products like the ones shown below.

Let’s look at the (ahem) nutrition in some of these heart-protecting foods. In a serving size that provides just 118 calories (boy, that’ll get you through the morning, won’t it?), Honey Nut Cheerios contain 23 grams of refined carbohydrates. Almost 10 of those grams are pure sugar. A cup of West Soy vanilla soy milk contains 21 grams of carbohydrates, including 10 grams of sugar. The instant oatmeal contains 31 carbohydrates including 12 grams of sugar, and the V-8 fusion juice may as well be a Coca-Cola: 25 grams of sugar in one cup.

So well-meaning people filling their grocery carts with products bearing the American Heart Association’s seal of approval could easily end up on a diet high in refined starches and sugars and think they’re doing their hearts a favor. I’m sure many have.

Meanwhile, more and more studies are suggesting that the whole arterycloggingsaturatedfat! theory was wrong. I just posted on one of those last week.

So image you’re a dedicated member of the American Heart Association. Evidence is piling up that the advice your organization has been handing out since the 1960s not only didn’t help, it probably caused actual harm. What can you do?

Well, you could call a press conference or take out ads in national newspapers and announce that you’ve been wrong all along, but that would likely spell the end of your organization. It would also mean looking yourself in the mirror and saying, “Oh my god … have I been promoting foods that turned people into fat diabetics? Have kids been diagnosed with ADHD and sent to special-ed classes because I told their parents Honey Nut Cheerios are a heart-healthy food? Have I told people to eat foods that sent their triglycerides through the roof and caused their bodies to produce small LDL particles? Has my advice killed people?”

Once we’ve taken a public position, it’s very difficult to admit we were wrong.

Psychologically, most of us need to believe we’re both good people and good decision-makers.

We are quite capable of fooling ourselves into believing things that simply aren’t true, even if that means ignoring clear evidence.

The book provides interesting (and unfortunately common) examples of those points in action. What happens when, say, a woman marries a guy who turns out to be an abusive creep? She runs out and gets a divorce, right?

Nope. Odds are she’ll spend years with the guy before dumping him, if she dumps him at all. Think about the three points above. When you get married, you’ve made a dramatic public statement: this is the one. It would be embarrassing to admit to your family and friends a year later that your marriage was a huge mistake – telling them, in effect, that in making perhaps the most important decision of your life, you chose badly. (I broke off an engagement in my early 30s, so I know all about that one.)

So the abused wife can, against all evidence, convince herself that her husband is actually a decent guy. Sure, he’s abusive, but it’s not really his fault. He’s just under a lot of stress, you see. It’s because other people treat him badly. It may even be her fault for aggravating him. And he’s nice to her once or twice per month, and that’s the real him, you see. He just needs more time and few breaks, and he’ll be nice all the time.

Another example the book gives is police and prosecutors who arrest an innocent man and send him to prison, only to see him exonerated years later by DNA evidence. You’d expect the prosecutors to say to themselves, “Wow, that’s horrible. We put an innocent guy away.” You’d also be wrong. Despite the large number of people who have been exonerated by new evidence, it’s exceedingly rare for a prosecutor to admit he or she put the wrong man in prison. As the authors recount, most prosecutors are still convinced – despite the evidence – that the guy they put away was guilty.

Once again, we’re talking about people who took a very public position (ladies and gentlemen, this is guy who committed the crime) and who need to think of themselves as good people (I’m the good guy because I put away bad guys.) To protect themselves psychologically, they can explain away the evidence that they were wrong. The alternative is to look in the mirror and admit they ruined an innocent person’s life, not to mention his family’s life.

As the authors note, people who insist they were right all along even when the evidence says they’re wrong aren’t usually lying. To lie, you have to know what you’re saying isn’t true. These people truly believe they’re right. That pesky new DNA evidence was probably planted, you see. The lab made a mistake. The guy committed the murder, but the DNA that doesn’t match his was left behind by an accomplice we didn’t know about. The guy we put in prison is guilty, damnit. Never mind the fact that the DNA left behind on the victim doesn’t match. You have to look at the totality of the evidence.

The American Heart Association and its sister organizations have been spreading arterycloggingsaturatedfat! hysteria for decades – in effect, prosecuting the innocent. They’ve recommended processed vegetables oils instead of animal fats. They’ve taken very public positions warning people away from high-fat foods and promoting breads, cereals, pastas, juices, and other foods low in fat but high in carbohydrates. And of course, they think of themselves as the good guys.

So no, they’re not going to admit they were wrong. They’re not going admit their advice may have killed people. They’re incapable of believing that. They’re going to show up in media articles and TV shows and blogs and insist they were right all along. Never mind that latest study, they’ll insist. You have to look at the totality of the evidence.

Actually, no, we don’t have to look at the totality of the evidence. We just need to examine some key evidence that falsifies their theories. I’ll cover that in my next post.

The film follows Donal – a lean, fit, seemingly healthy 41 year old man – on a quest to hack his genes and drop dead healthy by avoiding the heart disease and diabetes that has afflicted his family.

Donal’s father Kevin, an Irish gaelic football star from the 1960s, won the first of 2 All Ireland Championships with the Down Senior Football Team in 1960 before the biggest crowd (94,000) ever seen at an Irish sporting event.

When Kevin suffered a heart attack later in life, family and friends were shocked. How does a lean, fit and seemingly healthy man – who has sailed through cardiac stress tests – suddenly fall victim to heart disease?